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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198019318
Report Date: 10/28/2021
Date Signed: 10/28/2021 04:55:45 PM

Document Has Been Signed on 10/28/2021 04:55 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:MONTESSORI ACADEMY OF ARCADIAFACILITY NUMBER:
198019318
ADMINISTRATOR:EMILENE JULEFACILITY TYPE:
830
ADDRESS:940 W DUARTE ROADTELEPHONE:
(626) 447-2246
CITY:MONROVIASTATE: CAZIP CODE:
91016
CAPACITY: 28TOTAL ENROLLED CHILDREN: 25CENSUS: 17DATE:
10/28/2021
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
12:01 PM
MET WITH:Jasmin Vejar, TeacherTIME COMPLETED:
05:05 PM
NARRATIVE
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 Licensing Program Analyst (LPA) Cynthia Reyes, conducted an unannounced Case Management inspection regarding Deficiencies observed. LPA met with Jasmin Vejar, Teacher who took LPA on a tour of the facility. Census of children were taken, staff names and positions were documented. Due to COVID- 19 precautionary measures were taken during the entire inspection and all individuals present during this inspection wore appropriate personal protective equipment. Around 9:15 AM Suzy Karas arrived and identified herself as the Administrator. Director Emilene Jule arrived about 9:35 AM.

Citations are being issued for the following deficiency documented below due to deficiencies discovered during the course of an investigation: Conduct Inimical: Staff #12 was observed on video mistreating an infant in care. Personnel Requirements: Staff #12 was observed on video to have been handling an infant in a rough manner. Reporting Requirements: A staff member who is a mandated reporter stated witnessed a co-worker handling an infant in a rough manner and did not report it to the director or the department. Criminal Record Clearance: staff #10 has not been associated to the facility and has been working since 08/2021.

Per California Code of Regulations Title 22, Division 12, Deficiency are cited on this date. Upon receipt of this report, the Licensee shall post the Notice of Site visit and any licensing report documenting a type “A” deficiency. The report and the Notice of Site visit shall be posted for 30 consecutive days. Failure to maintain posting as required, will result in an immediate $100 civil penalty. A copy of this report shall be provided to the parent/guardian of children currently enrolled by the next business day or immediately upon return. A copy of this report shall also be provided to the parent/guardian of any newly enrolled children for the next 12 months (1 year). The Acknowledgement form must be maintained in each child’s file immediately upon receipt from parent. Licensee was provided with a copy of the parent Acknowledgement of Receipt of Licensing Reports Form during this visit



Exit interview conducted and report was reviewed with the Director, Emilene Jule.
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Cynthia Reyes
LICENSING EVALUATOR SIGNATURE: DATE: 10/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/28/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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Document Has Been Signed on 10/28/2021 04:55 PM - It Cannot Be Edited


Created By: Cynthia Reyes On 10/28/2021 at 02:27 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: MONTESSORI ACADEMY OF ARCADIA
FACILITY NUMBER: 198019318

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/28/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/28/2021
Section Cited
HSC
1596.885(c)

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Conduct Inimical: Conduct in the operation or maintenance of a child care center which is inimical to the health, morals, welfare, or safety of either an individual in or receiving services from the facility or the people of the State of California. The requirement is not met as evidenced by: Staff #12 was observed on video mistreating
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Director states the staff member is no longer employed and all infant staff had a training on Title 22 Regulations regarding Infant Care.
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an infant in care. Staff #12 was handling the infant in a rough manner. This is an immediate risk to the health and safety of children in care.
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Type A
10/28/2021
Section Cited
CCR101216(j)

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Personnel Requirements: Personnel shall provide for the care and safety of children without physical or verbal abuse, exploitation or prejudice. The requirement is not met as evidenced by: Staff #12 was observed on video to have been handling an infant in a rough manner. This is an immediate risk to the health and safety of children in care.
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The Director states that her and her staff will review the Department's Child Care Video Series at https://ccld.childcarevideos.org/ in regards to children's Personal Rights, which will assist with increasing the understanding of the Department’s role in protecting the health and safety of children. Director will submit proof correction has been made

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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Christina Gabelman
LICENSING EVALUATOR NAME:Cynthia Reyes
LICENSING EVALUATOR SIGNATURE:
DATE: 10/28/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/28/2021


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 10/28/2021 04:55 PM - It Cannot Be Edited


Created By: Cynthia Reyes On 10/28/2021 at 03:07 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: MONTESSORI ACADEMY OF ARCADIA
FACILITY NUMBER: 198019318

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/28/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/28/2021
Section Cited
CCR
101170(e)(2)

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Criminal Record Clearance: Prior to working or volunteering in a licensed child care facility, all individuals subject to a criminal record review shall request a transfer of a criminal record clearance from another facility or Trustline. The requirement is not met as evidenced by: During file review and LPA Licensing information system review
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Director handed LPA a copy of staff #10 transfer request form, LIC 508 and a copy of her drivers license to have the staff member associated to the facility. Staff #10 was verified by the department to be cleared in guardian.
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it was observed that staff #10 has not been associated to the facility and has been working since 08/2021. This poses a potential health and safety risk to the children in care. A $100 civil penalty will be assessed on this date.
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Type B
11/05/2021
Section Cited
CCR101212(d)

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Reporting Requirements: Upon the occurrence, during the operation of the child care center of any of the events specified in (d)(1) below, a report shall be made to the Department by telephone or fax within the Department's next working day and during its normal business hours. In addition, a written report containing the information specified in
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The Director states that her and her staff will review the Department's Child Care Video Series at https://ccld.childcarevideos.org/ in regards to Reporting Requirements, which will assist with increasing the understanding of the Department’s role in protecting the health and safety of children. Director will submit proof correction has been made.
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(d)(2) below shall be submitted to the Department within seven days following the occurrence of such event. This requirement was not met as evidenced by: Staff member who is a mandated reporter stated witnessed a co-worker handling an infant in a rough manner & did not report it. This is a potential risk to the health and safety of children in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Christina Gabelman
LICENSING EVALUATOR NAME:Cynthia Reyes
LICENSING EVALUATOR SIGNATURE:
DATE: 10/28/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/28/2021


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